Michael Stolten

Alternative Digit Ratios and Their Relationship to Prostate Cancer

BACKGROUND The ratio of the second to the fourth digits (2D:4D) has been linked to prenatal androgen exposure and prostate cancer (PCa). The use of alternative finger ratios has been shown to be a greater indicator of sexual dimorphism when compared with the traditional 2D:4D ratio. This study aimed to assess the relationship between alternative digit ratios, racial demographics, and clinical/pathologic parameters associated with PCa. MATERIALS AND METHODS Digital finger length measurements were made from scanned images of hands from patients with PCa. Race, age, family history, history of metastasis, and Gleason score at diagnosis were assessed in a cross-sectional clinic-based study. Demographic and clinical parameters were analyzed with respect to various alternative finger length ratios. RESULTS Hand measurements were obtained in 354 white and 98 African-American patients with PCa. African-American men were more likely to have a smaller 2D:3D (P < .0001) and 2D:4D digit ratio (P < .0001) in both hands. Larger right (R)3D:5D (P = .0005), R4D:5D (P = .0014), and R2T:2D (P = .0501) digit ratios were present in African-Americans compared with whites. In exploratory analyses, African-American men with a smaller left (L)2T:2D ratio were younger at the time of PCa diagnosis (P = .0125). No relationship was found between the various digit ratios and Gleason score, the presence of metastatic disease, or family history. CONCLUSION Various alternative finger length ratios show strong differences between African-American and white men in this study. The potential relationship between the 2T:2D ratio and age at diagnosis in African-Americans needs additional verification.

Characterizations of Clinical and Therapeutic Histories for Men With Prostate Cancer-Specific Mortality

BACKGROUND Careful descriptions of men with prostate cancer (PCa)-specific mortality are scant in nontrial settings. The present retrospective review describes the clinical characteristics, timelines, and treatment histories from initial presentation to death in a cohort of men with metastatic, castrate-resistant PCa (mCRPC). Unique to the present study is the unequivocal attribution of PCa death by a single experienced clinician. PATIENTS AND METHODS A total of 119 patients who had been treated at Tulane Cancer Center and had died of mCRPC from 2008 to 2015 were studied through a retrospective review of the medical records. RESULTS The median age at diagnosis was 65 years (range, 40-85 years), and 34.4% of the patients presented with metastatic disease (stage M1). Of these patients, 56% had received definitive primary therapy, all had received androgen-deprivation therapy, and 52% had received docetaxel. The patients had received a median of 7 (1-14) systemic therapies before death. Most were secondary hormonal manipulations after the diagnosis of mCRPC (median, 4; range, 0-9). The median survival was 69 months (range, 5-270 months) after diagnosis, and the median age at death was 73 years (range, 47-95 years). The presence of metastases at diagnosis was a significant predictor of early death (hazard ratio, 4.33; P < .001), and definitive primary therapy was a significant predictor of longer survival (P < .001). The median survival for patients presenting with metastases was 39 months (range, 5-235 months) compared with 100 months (range, 6-270 months) for those with localized disease (P < .001). The median age at diagnosis between the docetaxel- and non-docetaxel-treated patients was significantly different at 62 and 71 years, respectively (P = .002). CONCLUSION The present retrospective analysis provides initial views clarifying the clinical characteristics of men dying of mCRPC and the therapies they received before death. Additional data are needed in multi-institutional settings to confirm these findings.

Sequencing of treatments in metastatic CRPC for patients who have completed all therapeutic interventions.

339 Background: The current treatment paradigm for metastatic, castrate-resistant prostate cancer (mCRPC) has rapidly changed and six therapies [abiraterone (Abi), enzalutamide (Enza), docetaxel (Doc), cabazitaxel (Cab), radium-223 (Ra-223), and sipuleucel-T (Sip-T)] have now been proven to prolong overall survival. Though sequential therapy is the norm, few studies have reported on the variety and prevalence of these agents over the course of patients lifetime. Herein, we sought to describe the temporal frequencies of mCRPC therapies in patients who completed all of their therapies. Methods: Retrospective chart reviews were conducted on 119 patients who died from mCRPC at Tulane Cancer Center from 2008-2015 (thus completing all possible therapies). Many patients were not treated with multiple life-prolonging therapies given the timing of their death. Post-mCRPC therapies were longitudinally sequenced and a frequency table was generated for first, second, third, etc. line of therapies. Results: Median du...

Neonate with paraplegia

A newborn female presented with bilateral lower limb paralysis and anuria. Physical exam was notable for a mass on the right flank as well as the previously mentioned paraplegia. No facial defects or evidence of limb deformities were present. Both the course of pregnancy and delivery were unremarkable. Ultrasound performed at 18 weeks was normal by history. Spinal magnetic resonance imaging (MRI) demonstrated a heterogeneous retroperitoneal mass. The mass was inferior to the right kidney, displacing it superiorly. Both the inferior vena cava and the aorta were displaced anteriorly. The mass extended into the right paraspinous region and spinal canal, entering at L2-3 and L3-4 right neural foramina. It extended superior to T4 and inferiorly to L5-S1. C6 enhancement may have represented skip epidural metastasis. The lesion displaced the thecal sac/spinal cord from T6-T10. T10-L2 vertebral body had no identifiable spinal cord. No other metastatic foci were detected. The newborn also had bilateral hydronephrosis, which was more extensive on the right side (see Figures 1 and 2). Bone marrow aspirate, urine vanillylmandelic acid and homovanillic acid, metaiodobenzylguanidine scan, and a bone scan were all negative. Needle biopsy of the mass was performed and neuroblastoma or other small cell tumors were considered. Slides from the needle biopsy were sent to the Mayo Clinic for review. Morphological and immunohistology studies at Mayo confirmed the diagnosis of malignant rhabdoid tumor.

Facial Pain in a Child With Attention Deficit Hyperactivity Disorder

A 12-year-old African American female with a past history of attention deficit hyperactivity disorder and developmental delay presented with a 2-month history of left-sided eye pain and decreased sensation with burning and tingling over the V 1 and V 2 facial areas. She also reported ear fullness and possible hearing loss on her left side that coincided with the start of her eye pain. Patient described the pain as constant that was partially relieved by acetaminophen and use of ice packs. Patient also experienced episodes of coughing up blood in her sputum along with bloody nasal discharge that occurred 4 to 5 times over the past 2 months. In addition to these symptoms, the patient’s grandmother reported that the patient had occasional fever, sore throat with bleeding, constipation, nausea, and vomiting for the past 2 months. There were no reports of loss of consciousness, headache, aggression, altered mental status, or sudden loss of vision. She was seen several times over a month by her primary care physician and prescribed hydrocodone after a normal physical examination. Lack of complete pain relief and continued left orbital pain led to an ophthalmology consult. No obvious pathology was detected. Episodes of profuse epistaxis from the left nostril resulted in an ENT exam. ENT exam revealed a nasopharyngeal mass that was imaged by magnetic resonance imaging (MRI) and positron emission tomography (PET) computed tomography (CT) showing extension of the mass into the central nervous system. Biopsy revealed a Grade 3 nasopharyngeal carcinoma (NPC) that did not involve surrounding lymph nodes (see Figures 1 and 2).